基于解剖性瘘管切除内口封闭治疗复杂肛瘘临床研究

Clinical study of complex anal fistula treated by endorectal mucosal advancement flap combined with fistulectomy

目的探索解剖性瘘管切除术并直肠黏膜推移瓣封闭内口术治疗复杂肛瘘的临床疗效。方法选择208例复杂肛瘘患者根据其志愿分为联合治疗组(110例)和对照组(98例)。联合治疗组采取解剖性瘘管切除并直肠黏膜推移瓣封闭内口术治疗,对照组给予瘘管切除并挂线术治疗。观察两组病例临床治愈率、复发率和肛门失禁率。计量数据比较采用t检验,计数资料比较采用卡方检验。结果两组病例术后门诊随访24~48个月。术后12、24、48个月,治疗组患者复发率分别为7.9%、18.4%、21.1%,均低于对照组患者(25.8%、41.9%、48.4%);两组差异有统计学意义(χ^(2)=4.087、4.586、5.740,P<0.05)。术后2年治愈率治疗组[80.9%(89/110)]高于对照组[49.0%(48/98),χ^(2)=3.517,P<0.05],肛门失禁率治疗组[8.2%(9/110)]低于对照组[36.7%(36/98),χ^(2)=6.627,P<0.05]。两组差异都有统计学意义。结论解剖性瘘管切除并直肠黏膜推移瓣封闭内口术可以提高复杂肛瘘的治愈率,减少复发率和肛门失禁率。

Objective To investigate the clinical outcome of complex perianal fistulas treated by mucosal advancement flap(MF)combined with fistulectomy(FT).MethodsTotally,208 patients with complex perianal fistulas were treated.According to patients’own intention,110 patients were operated by MF combined with FT(MF&FT group),and 98 patients were treated by FT combined with seton(FT group).All patients were assessed retrospectively by case-note review and examined at the out-patient clinic.The localization and time of recurrence of the fistula were recorded and defecation function was determined.The t-test was used for the comparison of measurement data,and the chi-square test was used for the comparison of count data.ResultsThe patients in the two groups were followed up for 24-48 months after operation.After 12,24,and 48 months,the fistula had recurred in 9(8.2%),20(18.2%),and 23(21.0%)patients of the MF&FT group,and 25(25.5%),41(41.9%),and 47(48.0%)patients of the FT group,respectively(χ^(2)=4.087,4.586,5.740,P<0.05).The curative rate was 80.9%(89/110)in the MF&FT group,and 49.0%(48/98)in the FT group after surgery 24 months(χ^(2)=3.517,P<0.05).There were 9(8.2%)patients with defecation dysfunction in the MF&FT group and 36(36.7%)patients with defecation function in the FT group after operation(χ^(2)=6.627,P<0.05).ConclusionThe curative rate of complex anal fistula treated by mucosal advancement flap combined with fistulectomy increases in comparison with fistulectomy after operation.Recurrence and defecation dysfunction appear to be decreased by this treatment.